Health Education

Glaucoma treatment and medications

Cropped SingleCare logo By | January 17, 2020
Medically reviewed by Anis Rehman, MD

What is glaucoma? | Glaucoma diagnosis | Glaucoma treatment options | Glaucoma medications | Best glaucoma medications | Side effects of glaucoma | Glaucoma home remedies | FAQ | Resources

Approximately 3 million Americans are living with glaucoma, according to the Centers for Disease Control and Prevention (CDC). About half are not aware they have the disease. There is currently not a known cure for glaucoma.

What is glaucoma?

Glaucoma is a group of eye diseases affecting the optic nerve. The common feature is progressive damage to the optic nerve caused by high eye pressure, which can lead to permanent blurry or dimmed vision and could lead to blindness, especially if not properly treated, according to the Cleveland Clinic

There is no cure for glaucoma; however, if diagnosed and treated early, you can prevent further loss of vision. Vision loss occurring before diagnosis and treatment cannot be restored. Treatment aims to lower eye pressure (even if it is normal). 

Types of glaucoma

Glaucoma is typically caused by increased intraocular pressure (IOP) in the eye because fluids, called aqueous humor, do not drain properly. There are two main types of glaucoma. 

  • Primary open-angle glaucoma: This is the most common type of glaucoma. About 90% of people with glaucoma have open-angle glaucoma. There are rarely any early warning signs, and structures in the eye appear normal, but fluid does not drain properly. 
  • Chronic or acute angle-closure glaucoma: The remaining 10 percent of those with glaucoma have this type. The normal drainage passage is narrowed and becomes blocked so that fluid in the eye cannot drain. 

It is possible to develop glaucoma even if the pressure in your eye is normal according to the Cleveland Clinic, called normal-tension glaucoma.

Childhood glaucoma also referred to as congenital glaucoma. It occurs in babies and young children and is usually diagnosed within the first year of life. 

Anyone can develop glaucoma; however, those most at risk include: 

  • African-Americans over the age of 40
  • People with a family history of glaucoma
  • People who have diabetes
  • People who have had serious eye injury in the past
  • People who take corticosteroid medications
  • All people over the age of 60
  • People with hypertension 

How is glaucoma diagnosed?

In the early and moderate stages of open-angle glaucoma, there are generally no symptoms. Some people may first notice a loss of peripheral vision, which might not occur until the disease has progressed. “Generally, glaucoma progresses very slowly over the years—so much so that it is sometimes called the sneak thief of vision; it can creep up on you without you knowing,” explains Kaushal M. Kulkami, MD, a board-certified ophthalmologist with a private practice in New York City. “That said,” he further explains, “Any form of glaucoma that causes the intraocular pressure to shoot up can progress quickly.” 

Other symptoms, according to the National Eye Institute – National Institutes of Health (NEI-NIH), include: 

  • Redness in eyes
  • Vision in one or both eyes seems hazy
  • Seeing halos around lights
  • Narrowing of the visual field (loss of peripheral vision) called tunnel vision

The diagnosis of glaucoma begins with a comprehensive eye exam, which might occur as a routine visit or a person might be having some difficulty that prompted seeking medical advice. The exam includes a dilated procedure where eye drops to dilate or enlarge your pupils to allow more light into your eye allowing a doctor to see inside the eye. 

An ophthalmoscope might be used to check your eye’s interior and look for damage to your optic nerve and tonometry measures the pressure in your eyes, according to the NEI-NIH.  The exam is easy and painless; however, it can leave you more sensitive to light or give you blurry site for a few hours. It is recommended that patients have someone drive them home from an appointment.  

NEI recommends that people over the age of 60 have a dilated pupil eye exam every one to two years, and those with risk factors have regular exams after the age of 40. Your ophthalmologist should talk to you about the recommended frequency of exams. 

Angle-closure glaucoma can develop quickly and cause sudden symptoms, according to NEI-NIH. If you have any of the following symptoms, you should seek immediate medical care, either with your ophthalmologist or at the emergency room:

  • Intense eye pain
  • Stomach upset or nausea
  • Red-eye
  • Blurry vision

Glaucoma treatment options

Treatment aims to lower the pressure in your eyes, reducing the risk of additional vision loss. Any vision loss you experienced before treatment is permanent. There are several different types of treatment for glaucoma, according to NEI-NIH. 

Prescription medications

Prescription eye drops are usually the first line of treatment. Medicated eye drops lower pressure in the eyes by either promoting drainage of the fluid or reducing the amount of fluid. “Generally, once you start eye drops for glaucoma, you will need them the rest of your life,” Dr. Kulkami says. 

Laser treatment and surgery

Laser trabeculoplasty is used for open-angle glaucoma and completed in your doctor’s office. During this procedure, a laser helps fluid drain out of the eyes and reduce pressure in your eye. You might see some swelling, experience eye irritation, or have blurry vision immediately after treatment. Most people return to regular activities the next day. Laser iridotomy treats narrow-angle glaucoma and chronic angle-closure glaucoma. 

Two other types of surgery include:

  • Glaucoma implant surgery: This is used to treat several types of glaucoma and is done in the out-patient unit of the hospital. You go home the same day but will not be able to drive yourself home. A small tube or shunt is placed in the white of your eye to promote fluid drainage. 
  • Minimally invasive glaucoma surgery (MIGS): This is a new approach to treat glaucoma and is considered safer than implant surgery and allows you to recover faster. There are fewer complications than with implant surgery but might not be as effective. For this surgery, microscopic-sized equipment makes tiny incisions. 

There is ongoing research to find better treatments: 

  • Researchers at UC Berkeley and the University of Toronto have published findings they hope will lead to treatments that can halt the progression of glaucoma and lead to a cure. 
  • Catalyst for a Cure by the Glaucoma Research Foundation is bringing together experts in stem cell technology, neuroprotection, and nerve fiber regeneration to identify novel methods for reconnecting the eye and restoring vision in those who have lost it. 
  • The National Eye Institute is funding several studies to better understand what causes fluid pressure to increase in the eyes to better understand the cause and find ways to prevent and treat it. 

Glaucoma medications

There are two main categories of drugs for glaucoma. The first reduces pressure by increasing drainage. The second reduces the amount of fluid in the eye. Both work to lower eye pressure. 

Drugs used to increase fluid drainage

Prostaglandin analogs 

  • Xalatan (latanoprost)
  • Travatan (travoprost)
  • Lumigan (bimatoprost)
  • Rescula (unoprostone)
  • Timolol 
  • Tafluprost 

Side effects of these medications include darkening of eye color, increased growth of eyelashes, redness, itching, burning, and blurred vision. 

A relatively new drug, introduced in 2018, Vyzulta (latanoprostene bunod) is a prostaglandin analog that works by opening the uveoscleral pathway but also has added ingredient of nitric oxide, which dilates blood vessels to improve blood flow to the optic nerve.

Rho-kinase inhibitor

Rhopressa (netarsudil ophthalmic solution) is a medication introduced in 2017. These eye drops reduce pressure in the eyes by improving the outflow of the trabecular meshwork. Most drugs today target the secondary drainage system, the uveoscleral pathway, or reduce fluid. Rhopressa targets the primary drainage system. Years ago, some medications treated the meshwork, but they had severe side effects. People with normal or slightly elevated pressure where current medications are limited in their ability to lower pressure in these patients can also use this medication. 

Side effects include eye redness, corneal abnormalities, eye pain, and burst blood vessels in the eye.

Miotic or cholinergic agents

These lower pressure by tightening muscles in the eyes and help to open a drainage system and are rarely used. 

Side effects include decreased pupil size, blurred vision, poor night vision, nearsightedness, watering eyes, brow and eye aches, and possible allergic reactions. 

Eye drops that decrease fluid in the eyes

Beta-blockers

Side effects include respiratory problems, worsening asthma, lowered heart rate, and blood pressure, blurred vision, tiredness, forgetfulness, and changes in cholesterol levels. 

You should talk to the doctor if you are on other blocker medications or if you have asthma, heart disease, or low blood pressure before using beta blocker eye drops. 

Alpha-adrenergic agonists  

These are sometimes used after laser surgery to prevent a sudden increase in pressure. 

Side effects include dry mouth, burning sensation in eyes, dilated pupils, nasal congestion, and drowsiness

Carbonic anhydrase inhibitors 

Your healthcare provider might suggest these when other drugs have not been effective. Some might come in pill form, but these are rarely used due to their adverse effects.  

  • Neptazane (methazolamide)
  • Daranide (dichlorphenamide)
  • Azopt (brinzolamide hydrochloride)
  • Trusopt (dorzolamide hydrochloride)

Side effects for drops include stinging in eyes, feeling that something is in the eye and an odd taste in the mouth. Side effects for pills include fatigue, tingling in hands and feet, depression, frequent urination, anemia, kidney stones, loss of appetite, weight loss, diarrhea, and stomach cramps. 

Combination medications

  • Combigan (timolol, brimonidine tartrate): This medication is a combination of brimonidine and timolol and reduces pressure by increasing drainage and decreasing the amount of fluid in your eye. Side effects include burning, dry, itchy eyes, discharge from eye, redness, pain, swelling of eye or eyelid, stinging in eye, and tiny bumps on the lining of the eyelid. 
  • Cosopt (dorzolamide, timolol maleate): This medication is a combination beta-blocker and anhydrase inhibitor. The generic form of this medication is available. 

Combination medications are not used as initial treatment but in cases when two drugs are used. 

What is the best medication for glaucoma?

There are many choices of treatments for glaucoma, but there is no “best” medication. What works for one person might not work for another. Your eye doctor will take your type of glaucoma, medical condition, medical history, and other medication you are taking into consideration when suggesting a treatment for you.

Best medications for glaucoma
Drug Name Drug Class Administration Route Standard Dosage Common Side Effects
Xalatan 
(latanoprost)
Prostaglandin analogs Eye drops 1 drop in eye(s) per day Darkening of eye color, increased growth of eyelashes, itching, burning, blurred vision
Vyzulta 
(latanoprostene bunod)
Prostaglandin analogs Eye drops 1 drop in eye(s) per day Darkening of eye color, increased growth of eyelashes, itching, burning, blurred vision
Rhopressa 
(netarsudil ophthalmic solution) 
Rho-kinase inhibitor Eye drops 1 drop in eye(s) per day Eye redness, corneal abnormalities, eye pain, burst blood vessels in the eye
Timoptic 
Timoptic-XE 
(timolol maleate)
Beta-blockers Eye drops 1 drop in eye(s) twice a day Respiratory problems, lowered heart rate and blood pressure, blurred vision, forgetfulness
Alphagan
Alphagan-P 
(brimonidine tartrate)
Alpha-adrenergic agonists   Eye drops 1 drop in eye(s) three times a day Dry mouth, burning sensation, dilated pupils
Cosopt 
(dorzolamide, timolol maleate)
Combination Eye drops 1 drop in eye(s) twice a day Temporary blurred vision, cloudy vision, dry eyes, feelings as if something is in the eye
Combigan
(timolol, brimonidine tartrate)
Combination Eye drops 1 drop in eye(s) twice a day Temporary burning, stinging, itching, blurred vision, dry mouth

What are common side effects of glaucoma medication?

The following is not a complete list of possible side effects but might provide an overview of what you can expect when using eye drops for glaucoma.

  • Redness, itching or burning in the eyes
  • Feeling as if something is in the eye
  • Blurred vision
  • Darkening of eye color
  • Decreased pupil size
  • Changes in night vision
  • Watering eyes or discharge from eyes. 
  • Respiratory problems
  • Lowered heart rate and blood pressure
  • Odd taste in the mouth
  • Pain or swelling of eye or eyelid

What are the best natural remedies for glaucoma?

Glaucoma is a serious eye disease that can lead to blindness if not treated. It requires medical attention and treatment. There are no natural remedies to treat or cure glaucoma.  There are, however, some things you can do that might reduce your risk of developing glaucoma or reduce eye pressure. 

  • Limit caffeine: Caffeine may raise eye pressure. Although not statistically significant, caffeine can slightly increase intraocular pressure, according to the AAO. 
  • Exercise regularly: A study published in Medicine & Science in Sports & Exercise suggests physical exercise could reduce the risk of developing glaucoma by 40 percent or more. 
  • Sleep with your head elevated: Raising your head slightly while sleeping might reduce intraocular pressure, according to a study published in EyeAnother study found that sleeping with protective eyewear significantly reduced intraocular pressure. 

Some studies have suggested that marijuana is an alternative treatment for glaucoma. It is true that for a few hours after use, the intraocular pressure decreases minimally. The problem, according to the AAO, is that the pressure in your eyes needs to be controlled 24 hours a day and to do that with marijuana would require ingestion of 18 to 20 mg of THC, six to eight times a day, every day. This could potentially cause impairment in mood, mental clarity, the ability to drive or operate equipment and engage in other daily activities. Currently, marijuana is not a viable treatment for glaucoma. Both the American Glaucoma Society and the American Academy of Ophthalmology do not recommend marijuana for treatment of glaucoma.  

You can also improve your overall eye health and possibly reduce the risk of developing other eye conditions by eating a healthy diet with vitamins and nutrients that are important to eye health. The American Optometric Association indicates the following vitamins and nutrients might help improve overall eye health. 

  • Lutein and zeaxanthin can be found in green, leafy vegetables and eggs and might reduce the risk of chronic eye diseases
  • Vitamin C, found in citrus fruits, might reduce the risk of cataracts
  • Vitamin E, found in nuts and fortified cereals, protects cells in eyes
  • Zinc helps bring vitamin A from your liver to your retina to produce melanin which is a protective pigment in the eyes

Frequently asked questions about glaucoma

Which eye drops are used to treat glaucoma?

There are five major types of eye drops used to treat glaucoma. These are:

  • Prostaglandin analogs
  • Rho-kinase inhibitor
  • Beta-blockers
  • Carbonic anhydrase inhibitors
  • Alpha agonists

Also, there are combination eye drops which include prostaglandin analogs and beta-blockers, to both reduce pressure and improve drainage. 

What is the first sign of glaucoma?

Many people don’t notice symptoms in the early stages of glaucoma. The narrowing of the visual field, called tunnel vision, is often the first sign people notice, which can be after the disease has advanced.

Can glaucoma be stopped?

There is no cure for glaucoma currently; however, researchers are currently looking for a cure. Treatment can slow down or halt the progression of the disease but cannot reverse any loss of vision that has already occurred.

What foods to avoid if you have glaucoma?

Consuming caffeine in moderation is probably a good idea. Caffeine can cause a rise in intraocular pressure for about 90 minutes after consumption. However, it is not sure if this is significant in the development of glaucoma.  There is little evidence that avoidance of any other foods will prevent glaucoma.

Are there any natural remedies for glaucoma?

Glaucoma is serious and untreated, and it can lead to permanent blindness. While there are things you can do at home to lower your risk level, there isn’t any proven alternative treatment. It is best to see an ophthalmologist.

How dangerous is glaucoma?

Glaucoma can lead to vision problems, such as dimmed or blurry vision. Without proper treatment, it can lead to permanent blindness.

Related resources for glaucoma